ZRN 14 CLASS ASSIGNMENT

COURSE; MENTAL HEALTH

LECTURERS NAME: MR KUNDA

GROUP SIX (6)

GROUP MEMBERS NAMES
1.MWALE JAMIRA

2.MARION CHILESHE

3.NAOMI NKHOMA

4.MWALE ESAU

5.MWALE ANDIFORD

ASSIGNMENT QUESTION;

1. Antention hyperactive deficity disorder

2. Role of a nurse in group homes

Attention-deficit hyperactivity disorder (ADHD) is the current term for a specific

developmental disorder seen in both children and adults that is comprised of deficits in
behavioral inhibition, sustained attention and resistance to distraction, and the regulation of
one’s activity level to the demands of a situation (hyperactivity or restlessness).Attention
deficit hyperactivity disorder is one of the most common childhood disorders and can
continue through adolescence and adulthood. Symptoms include difficulty staying focused
and paying attention, difficulty controlling behavior, and hyperactivity.

MAJOR CHARACTERISTICS

The predominant features of this disorder include:

1. Impaired response inhibition, impulse control, or the capacity to delay gratification. This
is often noted in the individual’s inability to stop and think before acting; to wait one’s turn
while playing games, conversing with others, or having to wait in line; to interrupt their
responding quickly when it becomes evident that their actions are no longer effective; to
resist distractions while concentrating or working; to work for larger, longer-term rewards
rather than opting for smaller, more immediate ones; and inhibiting the dominant or
immediate reaction to an event, as the situation may demand.

2. Excessive task-irrelevant activity or activity that is poorly regulated to the demands of a

situation. Individuals with ADHD in many cases are noted to be excessively fidgety, restless,
and “on the go.” They display excessive movement not required to complete a task, such as
wriggling their feet and legs, tapping things, rocking while seated, or shifting their posture or
position while performing relatively boring tasks. Younger children with the disorder may
show excessive running, climbing, and other gross motor activity. While this tends to decline
with age, even teenagers with ADHD are more restless and fidgety than their peers. In adults
with the disorder, this restlessness may be more subjective than outwardly observable,
although with some adults they remain outwardly restless as well and report a new to always
be busy or doing something and being unable to sit still.

3. Poor sustained attention or persistence of effort to tasks. This problem often arises when
the individual is assigned boring, tedious, protracted, or repetitive activities that lack intrinsic
appeal to the person. They often fail to show the same level of persistence, “stick-to-it-
tiveness,” motivation, and will-power of others their age when uninteresting yet important
tasks must be performed. They often report becoming easily bored with such tasks and
consequently shift from one uncompleted activity to another without completing these
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activities. Loss of concentration during tedious, boring, or protracted tasks is commonplace,
as is an inability to return to their task on which they were working should they be
unexpectedly interrupted. Thus, they are easily distracted during periods when concentration
is important to the task at hand. They may also have problems with completing routine
assignments without direct supervision, being unable to stay on task during independent
work.

4. Remembering to do things, or working memory. Working memory refers to the capacity to

hold information in mind that will be used to guide one’s actions, either now, or at a later
time. It is essential for remembering to do things in the near future. Those with ADHD often
have difficulties with working memory and so are described as forgetful around doing things,
unable to keep important information in mind that they will need to guide their actions later,
and disorganized in their thinking and other activities as they often lose track of the goal of
their activities. They may often be described as acting without hindsight or forethought, and
being less able to anticipate and prepare for future events as well as others, all of which seem
to be dependent on working memory. ADHD cannot sense or use time as adequately as others
in their daily activities, such that they are often late for appointments and deadlines, ill-
prepared for upcoming activities, and less able to pursue long-term goals and plans as well as
others. Problems with time management and organizing themselves for upcoming events are
commonplace in older children and adults with the disorder.

5. Delayed development of internal language (the mind’s voice) and rule-following. ADHD
are significantly delayed in the development of internal language, the private voice inside
one’s mind that we employ to converse with ourselves, contemplate events, and direct or
command our own behavior. This private speech is absolutely essential to the normal
development of contemplation, reflection, and self-regulation. Its delay in those with ADHD
contributes to significant problems with their ability to follow through on rules and
instructions, to read and follow directions carefully, to follow through on their own plans,
rules, and “do-lists,” and even to act with legal or moral principles in mind. When combined
with their difficulties with working memory, this problem with self-talk or private speech
often results in significant interference with reading comprehension, especially of complex,
uninteresting, or extended reading assignments.

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6. Difficulties with regulation of emotions, motivation, and arousal. Children and adults with
ADHD often have problems inhibiting their emotional reactions to events as well as do others
of their age. It is not that the emotions they experience are inappropriate, but that those with
ADHD are more likely to publicly manifest the emotions they experience than would
someone else. They seem less able to “internalize” their feelings, to keep them to themselves,
and even to moderate them when they do so as others might do. Consequently, they are likely
to appear to others as less emotionally mature, more reactive with their feelings, and more
hot-headed, quick-tempered, and easily frustrated by events. Coupled with this problem with
emotion regulation is the difficulty they have in generating intrinsic motivation for tasks that
have no immediate payoff or appeal to them. This capacity to create private motivation,
drive, or determination often makes them appear to lack will-power or self-discipline as they
cannot stay with things that do not provide immediate reward, stimulation, or interest to
them. Their motivation remains dependent on the immediate environment for how hard and
how long they will work, whereas others develop a capacity for intrinsically motivating
themselves in the absence of immediate rewards or other consequences. Also related to these
difficulties with regulating emotion and motivation is that of regulating their general level of
arousal to meet situational demands. Those with ADHD find it difficult to activate or arouse
themselves to initiate work that must be done, often complain of being unable to stay alert or
even awake in boring situations, and frequently seem to be daydreamy or “in a fog” when
they should be more alert, focused, and actively engaged in a task.

7. Diminished problem-solving ability, ingenuity, and flexibility in pursuing long-term goals.

Often times, when we are engaged in goal-directed activities, problems are encountered that
are obstacles to the goal’s attainment. At these times, individuals must be capable of quickly
generating a variety of options to themselves, considering their respective outcomes, and
selecting among them those which seem most likely to surmount the obstacle so they can
continue toward their goal. Persons with ADHD find such hurdles to their goals to be more
difficult to surmount; often giving up their goals in the face of obstacles and not taking the
time to think through other options that could help them succeed toward their goal. Thus they
may appear as less flexible in approaching problem situations, more likely to respond
automatically or on impulse, and so are less creative at overcoming the road-blocks to their
goals than others are likely to be. These problems may even be evident in the speech and
writing of those with the disorder, as they are less able to quickly assemble their ideas into a
more organized, coherent explanation of their thoughts. And so they are less able to rapidly

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assemble their actions or ideas into a chain of responses that effectively accomplishes the
goal given them, be it verbal or behavioral in nature.
8. Greater than normal variability in their task or work performance. It is typical of those with
ADHD, especially those subtypes associated with impulsive behavior, to show substantial
variability across time in the performance of their work. These wide swings may be found in
the quality, quantity, and even speed of their work, failing to maintain a relatively even
pattern of productivity and accuracy in their work from moment to moment and day to day.
Such variability is often puzzling to others who witness it as it is clear that at some times, the
person with ADHD can complete their work quickly and correctly while at others times, their
tasks are performed poorly, inaccurately, and quite erratically. Indeed, some researchers see
this pattern of high variability in work-related activities to be as much a hallmark of the
disorder as is the poor inhibition and inattention described above.

OTHER CHARACTERISTICS

Several other development characteristics are associated with the disorder:

Early onset of the major characteristics. The symptoms of ADHD appear to arise, on average,
between 3 and 6 years of age. This is particularly so for those subtypes of ADHD associated
with hyperactive and impulsive behavior. Others may not develop their symptoms until
somewhat later in childhood. But certainly the vast majority of those with the disorder have
had some symptoms since before the age of 13 years. Those who have the Predominantly
InattentiveIn instances where heredity does not seem to be a factor, difficulties during
pregnancy, prenatal exposure to alcohol and tobacco smoke, prematurity of delivery and
significantly low birth weight, excessively high body lead levels, as well as post-natal injury
to the prefrontal regions of the brain have all been found to contribute to the risk for the
disorder in varying degrees. Research has not supported popularly held views that ADHD
arises from excessive sugar intake, food additives, excessive viewing of television, or poor
child management by parents. Some drugs used to treat seizure disorders in children may
increase symptoms of ADHD in those children as side effects of these drugs but these effects
are reversible.

CAUSES OR RISK FACTORS OF ADHD

Genes. Inherited from our parents, genes are the “blueprints” for who we are. This is due to

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the passed characteristics that children tend to inhereit from their parents by virtue of being
born from them which also has a great influence on how they do things, behave and interpret
the environment around them. Their ADHD symptoms also improved
Environmental factors. There is a potential link between cigarette smoking and alcohol use
during pregnancy and ADHD in children. The environment one is exposed to has a greater
significance on how people relate and interpret the world around them.

Brain injuries. Children who have suffered a brain injury may show some behaviours similar
to those of ADHD. However, only a small percentage of children with ADHD have suffered
a traumatic brain injury.

Sugar. The idea that refined sugar causes ADHD or makes symptoms worse is popular, but
more research discounts this theory than supports it. It is believed that children eat foods
containing either sugar or a sugar substitute every other day to develop this condition or
disorder.

Food additives.Consumption of certain food additives like artificial colors or preservatives,

and an increase in activity.

SUBTYPES

Predominantly Hyperactive-Impulsive Type

Those who have difficulties primarily with impulsive and hyperactive behaviour and not with
attention or concentration.

Predominantly Inattentive Type

Individuals with the opposite pattern, significant inattentiveness without being impulsive or
hyperactive are called thePredominantly Inattentive Type of ADHD appears to be associated
with more daydreaming, passiveness, sluggishness, difficulties with focused or selective
attention, slow processing of information, mental fogginess and confusion, social quietness or
apprehensiveness, hypo-activity, and inconsistent retrieval of information from memory. It is
also considerably less likely to be associated with impulsiveness as well as
oppositional/defiant behaviour, conduct problems, or delinquency. Should further research
continue to demonstrate such differences, there would be good reason to view this subtype as
actually a separate and distinct disorder from that of ADHD

Combined type of ADHD 5

However, combined ADHD, most individuals with the disorder will manifest both of these
clinical features as the Predominantly Inattentive Type and predominantly hyperactive
impulsive type .Combined Type, individuals develop their hyperactive and/or impulsive
symptoms first and usually during the preschool years. At this age, then, they may be
diagnosed as having the Predominantly Hyperactive-Impulsive Type. However, in most of
these cases, they will eventually progress to developing the difficulties with attention span,
persistence, and distractibility within a few years of entering school such that they will now
be diagnosed as having the Combined TypePredominantly Inattentive.

TREATMENT
No treatments have been found to cure this disorder, but many treatments exist which can
effectively assist with its management. Chief among these treatments is the education of the
family and school staff about the nature of the disorder and its management, in the case of
children with the disorder, and the education and counselling of the adult with ADHD and
their family members. Medical treatment that is given is therefore just to relieve the the signs
and symptoms of the disorder. The medication given includes;

Stimulants medications for this disorder such asmethylphenidate or Ritalin, d-amphetamine

or Dexedrine, Adderall, and, in rare cases, pemoline or Cylert.

Antidepressants, in particular desipramine, may also be effective in managing symptoms of

the disorder as well as co-existing symptoms of mood disorder or anxiety. However, these
antidepressants do not appear to be as effective as the stimulants. However, some individuals
with ADHD may require combinations of these medications, or others, for the management
of their disorder, often because of the co-existence of other mental disorders with their
ADHD. However, ADHD is the chronic medical disorder that requires ongoing treatment for
the effective management of the disorder even though it does not get rid of or cure the
disorder.

Psychological treatments, such as behavior modification in the classroom and parent training
in child behavior management methods produces short-term benefits in these settings. Some

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children with ADHD may benefit from social skills training provided it is incorporated into
their school program. Children with ADHD are now eligible for special educational services
in the public schools under both the Individuals with Disabilities in Educ. Adults with the
disorder may also require counselling about their condition, vocational assessment and
counselling to find the most suitable work environment, time management and organizational
assistance, and other suggestions for coping with their disorder.

Dietary management, such as removal of sugar from the diet, high doses of vitamins,
minerals, trace elements, or other popular and health food remedies., long-term
psychotherapy or psychoanalysis, biofeedback, play therapy, chiropractic treatment, or
sensory-integration training, despite the widespread popularity of some of these treatment
approaches.

Behavioral modefication, which icludes psychological, educational, and sometimes medical

evaluation followed by education of the individual or their family members as to the nature of
the disorder and the methods that assists with its management. Treatment is multidisciplinary,
requiring the assistance of the mental health, educational, and medical professions at various
points in its course. Treatment must be provided over long time periods to assist those with
ADHD in the ongoing management of their disorder. In so doing, many with the disorder can
lead satisfactory, reasonably adjusted, and productive lives.

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REFFERENCES
1.DSM-IV-TR workgroup. The Diagnostic and Statistical Manual of Mental Disorders,
Fourth Edition, Text Revision. Washington, DC: American Psychiatric Association.

2. Faraone SV, Perlis RH, Doyle AE, Smoller JW, Goralnick JJ, Holmgren MA, Sklar P.
Moleculargenetics of attention-deficit/hyperactivity disorder. Biological Psychiatry, 2005;
57:1313-1323.

3 Khan SA, Faraone SV. The genetics of attention-deficit/hyperactivity disorder: A literature

review of 2005. Current Psychiatry Reports, 2006 Oct; 8:393-397.

4 Shaw P, Gornick M, Lerch J, Addington A, Seal J, Greenstein D, Sharp W, Evans A, Giedd

JN, Castellanos FX, Rapoport JL. Polymorphisms of the dopamine D4 receptor, clinical
outcome and cortical structure in attention-deficit/hyperactivity disorder. Archives of General
Psychiatry, 2004